Individual
CHARLOTTE L SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1401 N 4TH AVE, SUITE 201, PURCELL, OK 73080-1806
(405) 527-5400
(405) 527-7332
Mailing address
1401 N 4TH AVE, SUITE 201, PURCELL, OK 73080-1806
(405) 527-5400
(405) 527-7332
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
746
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200229210A
—
OK
01
—
P00844211
RRMCARE THRU PFP
—
Enumeration date
06/07/2008
Last updated
07/18/2011
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